RN ADULT MEDICAL-SURGICAL NURSING CONTENT MASTERY
SERIES EDITION 12.0 (ATI CMS) 2026/2027 |
NGN CLINICAL JUDGMENT | 250 VERIFIED QUESTIONS AND
ANSWERS WITH RATIONALES
CONTENT AREAS:
Cardiovascular/Hematology (1–50) | Respiratory (51–90) | GI/Nutrition (91–130)
Renal/Urinary (131–160) | Endocrine/Metabolic (161–190)
Neurological/Sensory (191–220) | Musculoskeletal/Integumentary/Perioperative (221–250)
SECTION 1: CARDIOVASCULAR AND HEMATOLOGY (Questions 1–50)
Q1. Septic shock, norepinephrine 12 mcg/min, MAP 58, HR 128, PVCs. Anticipate?
A. Increase norepinephrine
B. 500 mL NS bolus over 15 min
C. Dobutamine 5 mcg/kg/min
D. Transcutaneous pacing
Correct: B. Fluid resuscitation improves preload; vasopressor toxicity (tachycardia,
PVCs) warrants volume expansion before increasing dose. A worsens arrhythmias;
C is second-line for myocardial dysfunction; D is for bradycardia.
Ref: Surviving Sepsis 2021; ATI Ch.10
Q2. CKD stage 4, K+ 6.8, peaked T waves. Given Ca gluconate, insulin, dextrose,
albuterol. Which finding shows immediate life threat resolved?
A. K+ drops to 5.5 in 30 min
B. ECG T-wave normalizes
C. U/O 40 mL/hr
D. Glucose 250 mg/dL
Correct: B. Ca gluconate stabilizes myocardium within minutes; ECG normalization
confirms cardiac protection. K+ lowering takes hours; U/O and glucose are
secondary.
Ref: ATI Ch.57; KDIGO 2024
1
,Q3. Post-op hip arthroplasty, sudden dyspnea, pleuritic pain, SpO2 88%, hx AFib
not on anticoagulation. First action?
A. O2 non-rebreather 15 L/min
B. Notify HCP
C. Prepare tPA
D. Stat ECG
Correct: A. ABCs first—correct hypoxia immediately. Then notify HCP. tPA is for
massive PE with instability; ECG is diagnostic but not first.
Ref: ATI Ch.21; AHA 2024 PE Guidelines
Q4. HFrEF prescribed sacubitril/valsartan. Which lab requires immediate action
before giving?
A. K+ 5.1
B. Cr 1.8
C. Na 132
D. BNP 850
Correct: B. Cr ≥2.5 (♀) or ≥3.0 (♂) is contraindication; hold and notify. Slight
hyperkalemia, mild hyponatremia, elevated BNP are expected.
Ref: ATI Ch.34; ACC/AHA/HFSA 2022
Q5. Acute coronary syndrome on heparin, aPTT 98 sec (normal 25–35). No
bleeding. Action?
A. Continue, recheck in 6h
B. Increase rate
C. Decrease rate by 2 units/kg/h and notify provider
D. Stop infusion
Correct: C. Therapeutic aPTT 60–85 sec; 98 is supratherapeutic. Reduce rate and
notify. Do not stop abruptly (rebound thrombosis).
Ref: ATI Ch.32; ACC/AHA 2023 ACS
Q6. Left-sided heart failure findings? (Select all)
A. Peripheral edema
2
,B. JVD
C. Crackles in bases
D. Paroxysmal nocturnal dyspnea
E. Hepatomegaly
F. Orthopnea
Correct: C, D, F. Left-sided = pulmonary congestion (crackles, PND, orthopnea). A,
B, E are right-sided failure.
Ref: ATI Ch.34
Q7. Severe aortic stenosis for valve replacement. Most concerning finding
requiring immediate notification?
A. Syncope with exertion
B. Angina
C. Systolic ejection murmur at RUSB
D. Sudden severe dyspnea + hypotension
Correct: D. Indicates acute decompensated HF or cardiogenic shock—emergency.
Syncope, angina, murmur are expected but not emergent.
Ref: ATI Ch.31; ACC/AHA 2020 Valvular
Q8. IV amiodarone for AF with RVR. Which finding indicates adverse effect
requiring HCP notification?
A. QTc 520 msec
B. BP 110/70
C. HR 85
D. Mild peripheral edema
Correct: A. QTc >500 msec increases torsades risk. BP and HR show therapeutic
effect; edema not primary amiodarone effect.
Ref: ATI Ch.33; ACC/AHA 2023 AF
Q9. Pericarditis. Which finding indicates life-threatening complication?
A. Friction rub
B. Pain worse supine
C. Pericardial effusion with pulsus paradoxus
3
, D. Fever 100.8°F
Correct: C. Pulsus paradoxus indicates cardiac tamponade—emergency. Rub,
positional pain, fever are expected.
Ref: ATI Ch.35
Q10. MI receiving tPA. Which finding indicates successful reperfusion?
A. Peak CK-MB
B. Decrease in ST elevation on ECG
C. Worsening chest pain
D. Elevated WBC
Correct: B. ST resolution indicates restored flow. CK-MB diagnoses MI; worsening
pain suggests failure; WBC is inflammatory.
Ref: ATI Ch.32
Q11. Digoxin level 2.4 ng/mL (therapeutic 0.8–2.0). Signs of toxicity? (Select all)
A. N/V
B. Yellow-green halos
C. Bradycardia
D. Constipation
E. Headache
F. Ventricular dysrhythmias
Correct: A, B, C, F. Constipation (D) and headache (E) are not classic signs.
Ref: ATI Ch.34
Q12. Enoxaparin (Lovenox) SQ. Which intervention prevents complications?
A. IM injection in ventrogluteal
B. Warm compresses
C. Remove air from prefilled syringe
D. Do not aspirate
Correct: D. Aspiration is contraindicated (tissue damage). Administer SQ in
abdomen; do not remove air bubble; warm compresses increase bruising.
Ref: ATI Ch.36
4
SERIES EDITION 12.0 (ATI CMS) 2026/2027 |
NGN CLINICAL JUDGMENT | 250 VERIFIED QUESTIONS AND
ANSWERS WITH RATIONALES
CONTENT AREAS:
Cardiovascular/Hematology (1–50) | Respiratory (51–90) | GI/Nutrition (91–130)
Renal/Urinary (131–160) | Endocrine/Metabolic (161–190)
Neurological/Sensory (191–220) | Musculoskeletal/Integumentary/Perioperative (221–250)
SECTION 1: CARDIOVASCULAR AND HEMATOLOGY (Questions 1–50)
Q1. Septic shock, norepinephrine 12 mcg/min, MAP 58, HR 128, PVCs. Anticipate?
A. Increase norepinephrine
B. 500 mL NS bolus over 15 min
C. Dobutamine 5 mcg/kg/min
D. Transcutaneous pacing
Correct: B. Fluid resuscitation improves preload; vasopressor toxicity (tachycardia,
PVCs) warrants volume expansion before increasing dose. A worsens arrhythmias;
C is second-line for myocardial dysfunction; D is for bradycardia.
Ref: Surviving Sepsis 2021; ATI Ch.10
Q2. CKD stage 4, K+ 6.8, peaked T waves. Given Ca gluconate, insulin, dextrose,
albuterol. Which finding shows immediate life threat resolved?
A. K+ drops to 5.5 in 30 min
B. ECG T-wave normalizes
C. U/O 40 mL/hr
D. Glucose 250 mg/dL
Correct: B. Ca gluconate stabilizes myocardium within minutes; ECG normalization
confirms cardiac protection. K+ lowering takes hours; U/O and glucose are
secondary.
Ref: ATI Ch.57; KDIGO 2024
1
,Q3. Post-op hip arthroplasty, sudden dyspnea, pleuritic pain, SpO2 88%, hx AFib
not on anticoagulation. First action?
A. O2 non-rebreather 15 L/min
B. Notify HCP
C. Prepare tPA
D. Stat ECG
Correct: A. ABCs first—correct hypoxia immediately. Then notify HCP. tPA is for
massive PE with instability; ECG is diagnostic but not first.
Ref: ATI Ch.21; AHA 2024 PE Guidelines
Q4. HFrEF prescribed sacubitril/valsartan. Which lab requires immediate action
before giving?
A. K+ 5.1
B. Cr 1.8
C. Na 132
D. BNP 850
Correct: B. Cr ≥2.5 (♀) or ≥3.0 (♂) is contraindication; hold and notify. Slight
hyperkalemia, mild hyponatremia, elevated BNP are expected.
Ref: ATI Ch.34; ACC/AHA/HFSA 2022
Q5. Acute coronary syndrome on heparin, aPTT 98 sec (normal 25–35). No
bleeding. Action?
A. Continue, recheck in 6h
B. Increase rate
C. Decrease rate by 2 units/kg/h and notify provider
D. Stop infusion
Correct: C. Therapeutic aPTT 60–85 sec; 98 is supratherapeutic. Reduce rate and
notify. Do not stop abruptly (rebound thrombosis).
Ref: ATI Ch.32; ACC/AHA 2023 ACS
Q6. Left-sided heart failure findings? (Select all)
A. Peripheral edema
2
,B. JVD
C. Crackles in bases
D. Paroxysmal nocturnal dyspnea
E. Hepatomegaly
F. Orthopnea
Correct: C, D, F. Left-sided = pulmonary congestion (crackles, PND, orthopnea). A,
B, E are right-sided failure.
Ref: ATI Ch.34
Q7. Severe aortic stenosis for valve replacement. Most concerning finding
requiring immediate notification?
A. Syncope with exertion
B. Angina
C. Systolic ejection murmur at RUSB
D. Sudden severe dyspnea + hypotension
Correct: D. Indicates acute decompensated HF or cardiogenic shock—emergency.
Syncope, angina, murmur are expected but not emergent.
Ref: ATI Ch.31; ACC/AHA 2020 Valvular
Q8. IV amiodarone for AF with RVR. Which finding indicates adverse effect
requiring HCP notification?
A. QTc 520 msec
B. BP 110/70
C. HR 85
D. Mild peripheral edema
Correct: A. QTc >500 msec increases torsades risk. BP and HR show therapeutic
effect; edema not primary amiodarone effect.
Ref: ATI Ch.33; ACC/AHA 2023 AF
Q9. Pericarditis. Which finding indicates life-threatening complication?
A. Friction rub
B. Pain worse supine
C. Pericardial effusion with pulsus paradoxus
3
, D. Fever 100.8°F
Correct: C. Pulsus paradoxus indicates cardiac tamponade—emergency. Rub,
positional pain, fever are expected.
Ref: ATI Ch.35
Q10. MI receiving tPA. Which finding indicates successful reperfusion?
A. Peak CK-MB
B. Decrease in ST elevation on ECG
C. Worsening chest pain
D. Elevated WBC
Correct: B. ST resolution indicates restored flow. CK-MB diagnoses MI; worsening
pain suggests failure; WBC is inflammatory.
Ref: ATI Ch.32
Q11. Digoxin level 2.4 ng/mL (therapeutic 0.8–2.0). Signs of toxicity? (Select all)
A. N/V
B. Yellow-green halos
C. Bradycardia
D. Constipation
E. Headache
F. Ventricular dysrhythmias
Correct: A, B, C, F. Constipation (D) and headache (E) are not classic signs.
Ref: ATI Ch.34
Q12. Enoxaparin (Lovenox) SQ. Which intervention prevents complications?
A. IM injection in ventrogluteal
B. Warm compresses
C. Remove air from prefilled syringe
D. Do not aspirate
Correct: D. Aspiration is contraindicated (tissue damage). Administer SQ in
abdomen; do not remove air bubble; warm compresses increase bruising.
Ref: ATI Ch.36
4
